Occlusion of Left and Right Coronary Arteries and Coronary Sinus Following Blunt Chest Trauma

Mastroroberto, Pasquale; Mizio, Giulio Di; Colosimo, Federica; Ricci, Pietrantonio

doi:10.1111/j.1556-4029.2011.01817.x

Cited by 10 publications

(11 citation statements)

References 8 publications

(12 reference statements)

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“…The left anterior descending artery is the most commonly injured coronary vessel. The type of injury varies; laceration, thrombosis, dissection, and fistula formation to an adjacent vein or a cardiac chamber have all been reported [30,31]. Electrocardiogram and troponin changes may suggest myocardial infarction [32].…”

Section: Cardiac Injuriesmentioning

confidence: 96%

Thoracic and Abdominal Injuries

Capan

Miller

2014

Anesthesia for Trauma

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Injuries to the thorax and the abdomen-the torso-contribute significantly to trauma-related mortality and morbidity. While the vulnerability of the closely organized vital organs to injury in this region plays an important role in morbidity and mortality, the noncompressible nature of hemorrhage in this area also contributes immensely to otherwise preventable trauma deaths. While it is estimated that one fourth of trauma deaths is secondary to chest trauma alone and claims about 16,000 lives per year [1], hemorrhage in the torso (thorax, abdomen, and pelvis) also results in a mortality of as much as 70-80 % after otherwise survivable noncerebral and noncardiac injuries in both civilian and military populations [2]. The overall mortality from exsanguination, which remains second to central nervous system (CNS) injury as a cause of death, primarily originates from injuries of the thorax, abdomen, and pelvis; there has been a reduction in death from extremity bleeding because of effective control with tourniquets or topical hemostatic agents, but not from torso bleeding. With increasing use of anticoagulant agents for prophylaxis and management of cardio-and cerebrovascular disorders, bleedingrelated mortality from truncal injuries is probably more frequent. For example, the predominant injury site in patients with cardiovascular disease who died after trauma in one study was chest in 15 % and abdomen in 3 % of instances; head and neck was the injury site in 69 % of patients [3].In 2008, of the more than 42 million injuryrelated emergency room visits in the United States only 4 % were due to torso injuries; the corresponding percentages for upper extremity injuries, lower extremity injuries, head and neck injuries, and vertebral injuries were 18 %, 15 %, 14 %, and 5 %, respectively [4]. Other diagnoses such as poisoning, adverse effects, ill-defined conditions, and mental disorders made up the remaining injury-related emergency room admissions [4]. Thus, although torso injuries represent a relatively small percentage of the emergency room load, they appear to cause a greater proportion of morbidity and mortality than other injuries.Up to 80 % of thoracic injuries coexist with other injuries in major trauma patients, but they require major surgery and anesthesia relatively infrequently. Yet undetected, relatively minor thoracic injuries may result in life-threatening events during surgery for associated injuries or intensive care management of the multiple trauma patient. Pneumothorax and hemothorax are perfect examples of this clinical situation. On the other hand, because of their sometimes silent nature, even major thoracic injuries (e.g., esophageal, diaphragmatic, and airway trauma) may be missed if appropriate diagnostic

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Section: Cardiac Injuriesmentioning

confidence: 96%

Thoracic and Abdominal Injuries

Capan

Miller

2014

Anesthesia for Trauma

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“…Many reported cases of coronary artery injury were the result of BCT from a road traffic collision, and the characteristic histological finding is compression of the lumen by hematoma at the site of dissection or surrounding the artery [1][2][3][4][5][6]. Coronary artery rupture is also possible [7], although it has been reported rarely in recent years [8][9][10].…”

Section: Introductionmentioning

confidence: 95%

Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography

et al. 2015

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Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.

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“…Mortality associated with blunt chest trauma is up to 15% 2. Acute myocardial infarction (AMI) following blunt chest trauma is rare.…”

Section: Introductionmentioning

confidence: 99%